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The NHS in England faces a funding crisis this year or the next, as it runs out of easy ways to save money and service transformation remains a distant prospect, the think tank the Nuffield Trust has concluded in a new report.1

Charged with making efficiency savings of 4% a year to balance the books, commissioners and NHS trusts are missing the target by a growing margin, making smaller and smaller savings each year. In 2013-14 clinical commissioning groups made savings of less than 2% of their total spending, while NHS foundation trusts achieved 3%. Although numbers of permanent staff have been cut, spending on agency staff to fill the gaps has risen swiftly enough to swallow any savings. In 2013-14 foundation trusts’ spending on agency staff rose 27%, …